Posts Tagged 'pregnancy'

The safety of antidepressants in pregnancy

Maternal antidepressants are implicated in ADHD, but so is maternal depression

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The safety of antidepressants in pregnancy is controversial, partly because of profound methodological difficulties in separating the fetal effects of antidepressants from those related to maternal depression (confounding by indication). One central concern is the potential impact of these drugs on fetal brain development. Such effects may be subtle and possibly only detectable years after exposure, such as an increased susceptibility to (multifactorial) neurodevelopmental conditions.

Women are unaware of pregnancy risks linked with sodium valproate

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Doctors are being asked to make sure that women and girls with epilepsy know about the risks of taking sodium valproate during pregnancy, after a survey found that half of those questioned were unaware that it could harm the fetus.

The charities Epilepsy Action, Epilepsy Society, and Young Epilepsy conducted a survey earlier this year, in conjunction with the Medicines and Healthcare Products Regulatory Agency (MHRA), of 2788 women aged 16 to 50 with epilepsy.

Oral antifungal is associated with increased risk of miscarriage

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Use of the oral antifungal drug fluconazole during pregnancy was associated with an increased risk of miscarriage in an analysis of 1.4 million pregnancies in Denmark published in JAMA.

Vaginal candidiasis is common during pregnancy. Although intravaginal formulations of topical azole antifungals are the first line treatment for pregnant women, oral fluconazole is often used in cases of recurrence or severe symptoms or when topical treatment has failed.

Antenatal and postnatal mental health: clinical management and service guidance

Antenatal and postnatal mental health: clinical management and service guidance

This updated guideline from NICE makes recommendations for the recognition, assessment, care and treatment of mental health problems in women during pregnancy and up to 1 year after childbirth, and in women who are planning a pregnancy.

 

 

Home rather than hospital for low risk pregnancies

Extract from National Health Executive

398BAB -8514“New guidelines from NICE could see thousands more babies born outside of hospital every year.

Nearly 700,000 babies were born in England and Wales last year, nine out of 10 of whom were delivered in hospital under the ultimate supervision of obstetricians, but NICE wants women to be given greater freedom to choose where they give birth.”

Read the full story here

Eyes on Evidence: April edition

This month in Eyes on Evidence

E-cigarette awareness and use to quit smoking
A survey suggests that awareness and use of e-cigarettes has increased over the past few years, but a randomised controlled trial indicates that the products are only modestly effective at helping people to quit smoking.

Beta-2 agonists and exercise-induced asthma
A Cochrane review has assessed the effects of short and long-acting beta-2 agonists for the prevention of exercise-induced asthma in adults and children; the majority of included studies assessed the effect of a single dose of a beta-2 agonist. The Medicines and Healthcare Products Regulatory Agency has previously issued advice recommending that long-acting beta-2 agonists should not be prescribed for the relief of exercise-induced asthma symptoms in the absence of regular inhaled corticosteroids.

Blood pressure control with home telemonitoring and pharmacist management
A US-based cluster randomised trial indicates that home telemonitoring with pharmacist medication management provides better blood pressure control than usual primary care, even once telemonitoring has finished.

Risk factors for congenital abnormalities
A prospective study of a UK multi-ethnic birth cohort suggests that consanguinity is a major risk factor for congenital abnormalities, in particular in children of parents of Pakistani origin.

Antidepressant use late in pregnancy and risk of postpartum haemorrhage
A cohort study of women with low income in the USA suggests that use of antidepressants near delivery is associated with an increased risk of postpartum haemorrhage.

CT scans in childhood or adolescence and risk of cancer
A population-based cohort study in Australia suggests that people who undergo CT scans in childhood or adolescence are at increased risk of developing solid, lymphoid and haematopoietic cancers.

Evidence Updates
NICE has recently published an Evidence Update on:
Alcohol-use disorders: preventing harmful drinking

Eyes on Evidence – October 2013

 

 This month in Eyes on Evidence
A Cochrane review notes that training in patient-centred approaches for healthcare professionals may have positive effects on patients’ experiences of consultation processes.
A Danish case-control study finds that use of glucocorticoids is associated with an increased risk of venous thromboembolism.
A cohort study shows that women who gain large amounts of weight during pregnancy are at increased risk of needing operative delivery.
A prospective population study suggests that, compared with bag-valve-mask ventilation, advanced airway management is associated with lower rates of favourable neurological outcomes after out-of hospital cardiac arrest.
A study suggests that British Pakistani girls may be less active than British white girls during school break times.
We would like your examples of how health and social care staff are helping to improve quality and productivity.
NICE has recently published Evidence Updates on:
  • Obsessive-compulsive disorder

Maternity guidance for doctors in training

This factsheet from NHS Employers, provides guidance for doctors in training who need to plan maternity leave. The factsheet includes information on timelines for telling your employer you are pregnant, when to take maternity leave, maternity pay and advice for doctors in training who may be moving between employers. It also includes a helpful flowchart, which gives an indication of actions to take and what to expect when planning maternity leave.

NB: Employers need to be aware of the potential for overpayment in circumstances where a doctor moves on rotation at a late stage of the pregnancy when SMP and NHS maternity pay may be paid by different employers. The two employers involved will need to liaise closely to ensure that total pay is at the correct level.

Maternity issues for doctors in training

Eyes on Evidence: Weight management during pregnancy

Feet on ScalePregnancy is thought to be an ideal time for health professionals to discuss weight management because women are motivated to make changes that will benefit themselves and their baby.   Across Europe and the USA, up to 40% of women gain more than the recommended weight in pregnancy (Thangaratinam and Jolly 2010). Excessive weight gain during pregnancy is associated with a number of serious health problems, including hypertension, gestational diabetes, and pre-eclampsia.
 
Current advice: There are no evidence-based UK guidelines on recommended weight-gain ranges during pregnancy. NICE recommends that weight loss programmes should not be used during pregnancy as they may harm the health of the unborn child. However, health professionals are advised to dispel any myths about what and how much to eat during pregnancy. For example, there is no need to ‘eat for 2’ or to drink full-fat milk. Energy needs do not change in the first 6 months of pregnancy and increase only slightly in the last 3 months (and then only by around 200 calories per day).
 
NICE advises that women stay active during pregnancy. Moderate-intensity physical activity will not harm a pregnant woman or her unborn child. At least 30 minutes of moderate intensity activity is recommended each day.

NICE News in December

    NICE local formularies guide will “reduce variation in prescribing”

    December 17, 2012

    NHS should offer early pregnancy services seven days a week

    December 12, 2012

    Greater awareness of hepatitis B and C needed

    December 12, 2012

    Recent press releases: Dec 18 2012

    Andrikopoulou M.; Sridhar A.N.; Nausheen S: BJOG: June 2012

    A complicated case of small bowel obstruction in pregnancy: A case report and review of literature

    BJOG: An International Journal of Obstetrics and Gynaecology, June 2012, vol./is. 119/(106-107), 1470-0328 (June 2012)

    Author(s): Andrikopoulou M.; Sridhar A.N.; Nausheen S.

    Institution: (Andrikopoulou, Sridhar, Nausheen) Macclesfield District General Hospital, United

    Conference Information: 10th International Scientific Congress of the Royal College of Obstetricians and Gynaecologists, RCOG 2012 Kuching, Sarawak Malaysia. Conference Start: 20120605

    Publication Type: Journal: Conference Abstract

     

    Extracts from BMJ: June 14 2012

    Srividya Seshadri, Pippa Oakeshott, Catherine Nelson-Piercy, and Lucy C Chappell

    Aumeer, R: Obesity Reviews, May 2011

    Audit on body mass index in pregnancy
    Citation: Obesity Reviews, May 2011, vol./is. 12/(199), 1467-7881 (May 2011)
    Author(s): Aumeer R.
    Introduction and background: Obesity during pregnancy is a risk factor for many adverse outcomes such as stillbirth, macrosomia, and gestational diabetes, among others.
    Objective: To assess the quality of care and management of obese pregnant women at Dudley Hospital, United Kingdom.
    Design: A retrospective audit study.
    Setting: Dudley Hospital, Birmingham, United Kingdom.
    Standards and criteria: All pregnant women should have their body mass index (BMI) measured and recorded at their first prenatal visit. All pregnant women with BMI > 30 should have postprandial blood tests at 20 weeks and 26 weeks to screen for diabetes. All pregnant women should receive advice about sensible diet and exercise, which should be documented in their medical notes.
    Methods: Medical records for all patients with delivery dates between December 2008 and January 2009 were audited post delivery.
    Participants: Pregnant women (N = 91).
    Results: BMI is recorded for 98% of patients. Over a quarter of women with BMI > 30 did not have postprandial blood tests at 20 and 26 weeks.
    Conclusion: BMI is calculated and recorded for most patients, but uptake of postprandial blood tests is suboptimal in patients with BMI > 30.
    Recommendations: To add a section on obesity in the maternity notes.
    Institution: (Aumeer) East Cheshire NHS Trust, Macclesfield, United Kingdom


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